Provider Demographics
NPI:1770683641
Name:JOHNSON, ALLISON M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 E MILLSAP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4095
Mailing Address - Country:US
Mailing Address - Phone:479-463-3070
Mailing Address - Fax:479-463-3077
Practice Address - Street 1:688 E MILLSAP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4095
Practice Address - Country:US
Practice Address - Phone:479-463-3070
Practice Address - Fax:479-463-3077
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4712207R00000X
PAMD432823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162911001Medicaid
ARP00375097OtherRAILROAD MEDICARE
ARE4712OtherTRICARE
AR06070016900OtherQUALCHOICE
AR162911001Medicaid
ARE4712OtherTRICARE